Does anyone have issues with the ability to talk loudly? If so, what is your diagnosis? At certain times of the day, it feels as if my head is rattling or vibrating when I talk at a normal volume so I have to speak softly. I assume it has to do with blood flow to the head. Given that I an new to the board, I will briefly introduce myself and tell my story. My first issues started last August, when I felt tremor type symptoms and subsequent lightheadedness. My wife took me to the ER where of course my vital signs were all normal. I made a trip to the Cleveland Clinic later that week (they even offered me same day appointments) where I was diagnosed with likely neurocardiogenic (pre)syncope. I had a tilt table test and was only able to take a few minutes upright so the results were non conclusive. I was short of breath afterwards and the doc sent me to the ER for the third time that week (I have resisted any further ER visit as there isn't much the staff has done for me other than inquire about anxiety problems). Since this time I have struggled with consistent lightheadedness, dizzy spells, headaches, head flashes (hard to describe some symptoms) and just a general overall crappy feeling. I frequently feel like I am going to pass out but haven't yet. An odd aspect of my condition is that my blood pressure has been normal to elevated in many cases when I have felt close to passing out. We went to a wedding in the mountains and I really struggled with the altitude as I felt tremors again followed by disorientation, as I felt as if I was in a stupor and even had trouble speaking clearly. I followed guidance from the Cleveland doctor and tried compression stockings and salt loading with no discernible results. I was previously diagnosed with sleep apena and was finally given a CPAP machine. I was able to use the machine at times, but my head is very sensitive since the symptoms started, and sometimes the (light) air pressure makes me feel like I am going to pass out so I stopped using. I recently saw a neurologist at the University of Washington who ordered a second tilt table test. This time, I was able to tolerate more than ten minutes standing. There wasn't much of a heart rate increase after standing (never went above the 60s) and my blood pressure continually dropped after a small increase, down to 60/40. The conclusion was that I have some kind of sympathetic dysfunction and a possible baroreceptor issue. Based on the results, I had a brain MRI and neck MRA that turned up negative. The doctor indicated that there was no evidence of multiple systems atrophy but it can't be definitively ruled out yet. I have been taking florinef for two plus months, which has raised my normally low blood pressure to borderline hypertension levels. Unfortunately, my symptoms have seemed to get worse. I have been taking atenolol my entire adult life for skipped heart beats/pvs. Use of the medication has been optional and has helped reduce symptoms for me but leaves me with a resting heart rate in the low 40s. The neurologist feels the next treatment steps are to 1) drop the atenolol by half and then eliminate after a few weeks to raise my heart rate (I started and my hr has increased but symptoms seem even worse) 2) increase salt loading to at least 9-10g daily and 3) start mididrone. The past five months have been incredibly frustrating as it feels like my entire body is falling apart. The day before I went to the ER with my first symptoms I had a vigorous bike ride around San Juan Island with several thousand feet of elevation gain. I was having a good summer and was participating in runs and triathlons, hiking, dining out (have had to end my beer and wine tasting hobbies), traveling and enjoying time with my wife and daughter. From one day to the next I felt like a different person and have become a couch potato. Despite the condition, I push myself to go to the gym as frequently as possible and lift weights and do light cardio activity as I don't want to completely decondition. Anyway, that is my story. Feel free to respond if you have also had the head vibrating issues or any other commentary regarding my condition. I look forward to sharing my experiences and learning from others on the board. It is good to have found people that share some of the same problems and find hope for better treatment options and ways to cope.